After a particularly heavy Saturday night-Sunday drinking session by Western Suburbs players years ago, I decided it was time for a lecture on the dangers of alcohol.

"Every time you get pissed, you destroy hundreds of thousands of brain cells," I declared.

"Brain cells are the only ones in the body which don't regenerate."

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One player looked at me with innocent wonder and said, "Geez, you must have been bright once."

Since my nickname was "Thirsty" and I still had a few marbles left, it was a backhanded compliment.

The story highlights the same lack of science being applied to the debate about concussion, where repeated head knocks also cause a loss of brain cells.

At a recent conference of NRL club chief executives, a presentation on concussion was made by Dr Paul McCrory, who is based in Melbourne and does consulting work for the AFL.

According to club bosses, Dr McCrory showed a table of sports, based on concussion injuries, with equestrian/horse riding head injuries clearly the worst.

The usual culprits, such as boxing, followed, with rugby league slightly more "dangerous" than rugby union, but less "dangerous" than Australian football.

It excited some of the club bosses under siege from the AFL, particularly when others explained that when two opposing AFL players are running to catch a ball, they have eyes only for it, with consequent, occasional head clashes.

Furthermore, hits in AFL can come from any direction, while there are parallel lines of attack and defence in the rugby codes and the ball carrier usually has time to partially cover up before high contact.

But statistics don't always tell the story, including the bizarre place of NFL near the bottom of Dr McCrory's table.

If it rates head injuries as a percentage of overall injuries, it explains why equestrian/horse riding is No 1.

That is, if you fall off a horse and have an injury, there is a big chance it will be to the head.

It was not possible to clarify Dr McCrory's methodology, with his receptionist saying, "He does not speak to the media."

Does this lead us to conclude American kids should be banned from riding bikes?

The other area where there needs to be caution with the statistics of concussion and sport is in terms of trends, with some zealots predicting the end of contact sport within 50 years.

A study by the US Centers for Disease Control and Prevention is relevant in this trend discussion.

Data shows that from 2001 to 2009, the number of sport and recreation-related emergency department (ED) visits for traumatic brain injury (TBI) among people aged less than 20 years of age increased by 57 per cent, from 190 per 100,000 people to 298 per 100,000. Does this mean concussion, a mild TBI, is on the rise?

A US federal government study that examined these statistics concluded it could possibly reflect an increased incidence of TBI among participants, and/or an increased awareness of the importance of early diagnosis of TBI. Because the number of ED visits for TBIs that resulted in hospitalisation did not trend upward significantly, the study concluded that increased awareness likely contributed to the increasing number of ED visits for TBI.

That is, the number of cases per 100,000 people resulting in hospitalisation had not increased, merely the public's awareness of concussion as a problem.

This is a good outcome, in the same way the current debate about concussion can also lead to more awareness by mums, dads and participants.

But comparing sports and declaring trends is dangerous while there is no accepted definition of an injury, let alone concussion.

Rugby union was the first code to mandate temporary substitutions for head injury assessments in February 2012, followed by the AFL at the beginning of 2013 and the NRL in 2014.

Dr Martin Raftery, a former Cronulla first-grade winger and now the chief medical officer for the International Rugby Board says: "It is very problematical comparing sports because the definition of injury across sports differs and there is no clear-cut operational definition for diagnosing concussion."

Nor is there any consensus on what causes a pea-size brain in a 70-year-old.

Should my grey matter be a similar size at a future autopsy, Western Suburbs players won't be sure whether it was the schooners or the face slapping.

21 comments so far

Martin Raftery played five eighth.

Commenter

Hansard

Date and time

March 19, 2014, 5:07PM

Roy, now you have let your age slip you should know we have at least one thing in common although I am a tad in front of you unfortunately. I can remember in my formative years walking to Central Station from the SCG and when you reached the Devonshire Street Entrance you met by a number of papers sellers offering you the "Last race Sun". it was the days when there was a paper seller on every corner. Nearly all of them were a bit worst for wear and looked like they had "gone a round or two for a pound or two" as the saying then went. My view was they were a by product of the fight game from the 1920's to the 1950's when there was a proliferation of prize fights in Sydney. You never see men who are "Punchy" like you did in the 1950's and 60's these days. Science or not it is something we should not take our eye off as there are enough thirsty old blokes who have done a bit of damage to the grey cells pottering around as it is.

Commenter

Rob

Location

Gymea Bay

Date and time

March 19, 2014, 5:14PM

A dangerously naive take on the issue. Very weak argument and a case of massaging statistics to try and play a pathetic "our sport isn't as bad as their sport" game.

The parties pushing the concussion issue are out to target a particular sport - they are out to target the misguided management of head injures across the board, regardless of the game being played.

It has always defied logic that boxing, union and league all had different mandatory rest periods for head injuries - that demonstrates the lack of science.

Why would a Western Suburbs rugby league player feel he was entitled to make a statement on science or the lack of science? How would he respond if a CSIRO scientist strolled into the change rooms in the 80's and started telling the Magpies how to play in the second half?

Was T Raudonikis a scientist?

Commenter

Dr Bilby

Location

Coogee

Date and time

March 19, 2014, 7:16PM

Well said, Dr Bilby. If any doubt exists (although I don't believe that any does exist), surely the prudent course would be to err on the side of caution until empirical evidence becomes compelling.

The greatest heavyweight boxer I've ever seen is now a shambling, mumbling wreck, and it's sure as hell not because of all the schooners he consumed.

I'm not only old enough to remember when cigarettes weren't bad for us, I can even remember when some of them were actually good for us. Anything's possible, if you fudge the figures properly.

Not your best efffort, Roy. I suggest you go and have a beer (oops!) with Fitzy.

Commenter

Lewis Winders

Location

Tasmania

Date and time

March 20, 2014, 2:56PM

Roy is as entitled to make statements on the science of this issue as you are to make statements on the purpose of his article. If you don’t believe he’s entitled to speak about this issue then guess what, you should have remembered that when you took the liberty to surmise what the point of his article was. You’re a Doctor, not a writer or a mind-reader after all.

Now, given that doctors and health professionals are not unanimous on the treatment or management of concussion then that really does suggest a lack of science. Likewise, statistics that can be interpreted any manner of ways that can paint whatever picture one chooses to portray, this again suggests a lack of science. Apart from science, there’s also a lack of context surrounding this concussion issue with this article being one of the first to widen its gaze past that of the football pitch and squared circle.

This issue is like most issues, it involves a series of processes and one doesn’t need to be an expert in any of them to grasp an understanding of the full picture much like one doesn’t need to be a health professional to run a hospital.

Commenter

A O

Location

Down South

Date and time

March 20, 2014, 8:07PM

Cyclists wear helmets and so do people who ride horses. Unlike league, they do not try to deny the heightened risk of head injuries and brain damage to protect their commercial interests. They wear helmets.

Not league. It tries to create confusion - 'look at some other sport,' or 'the science is out on that one,' or 'the concussion debate lacks science.' Stop copying the US NFL playbook. It is indefensible and just as cynical as the cigarette companies back in the day.

What I don't like is that League is cynically trying to play down the risk of head and brain damage to protect its commercial position. It is copying the US NFL playbook. Boooo.

Commenter

Suomessa

Location

Sydney

Date and time

March 19, 2014, 7:26PM

Sorry mate but any confusion surrounding this issue is due entirely to a lack of science and hard evidence. There is a severe lack of NRL based medical evidence and an overabundance of NFL sourced evidence. Both sports are collusion sports but you only has to watch a handful of NFL/NRL games to notice the giant, overwhelming gulf between the type of collisions both sports engender.

Hard fact, hard evidence, general consensus and this issue goes away. Such factors are non-existent hence the so-called confusion.

Commenter

A O

Location

Down South

Date and time

March 20, 2014, 8:10PM

I dont understand why any players at any level should have to take punishment to their head. What does society gain by allowing a game to inflict head injuries to its players? Professional players have enough injuries to live with for the rest of their lives so why would any one want to add head injuries to them. So what if the science is inconclusive, There are enough players who feel they have suffered some sort of head injury. To argue that they are all wrong is avoiding the problems they have suffered while playing a game. Of course the ultimate test would be for commentators to allow players to hit them in the head at least 4 or 5 times a week over 10 years. You and your mates would agree to that wouldn't you Roy? The players could call it a game and then it would be acceptable to you and you mates to have it done to them..

Commenter

swannlake

Location

Canberra

Date and time

March 19, 2014, 11:20PM

Remember, attacking the head is illegal and almost always has been. A point you would know if you had any rudimentary understanding of the sport.

Commenter

A O

Location

Down South

Date and time

March 20, 2014, 8:12PM

First you need to pick the correct statistic to get a valid comparison of the risk in different sports or activities.

The correct statistic to compare sports is number of head injuries per 100,000 hours of sporting activity - not per 100,000 people. For every 100,000 hours playing Rugby League, how many head injuries compared with the same time spent doing other sports? The longer you play sport the more likely you are to get injured. The more you ride a bike the more likely you are to have a fall. The more RL games you play the more you will get hurt.

The total time spent by US kids riding bikes is far greater than the total time spent playing Gridiron. Don't ride or play at all and the risk is zero. Professionals will get hurt more often than amateurs or couch potatos for this reason. But that doesn't mean we should all become couch potatos.